Sakamoto Takahiko, Harada Yorikazu, Kosaka Yoshimichi, Umezu Kentaro, Yasukochi Satoshi, Takigiku Kiyohiro, Matsui Hikoro, Inoue Nao
Department of Cardiovascular Surgery, Nagano Children's Hospital, Azumino-City, Nagano, Japan.
World J Pediatr Congenit Heart Surg. 2011 Oct 1;2(4):558-65. doi: 10.1177/2150135111415428.
Background. The purpose of this study was to evaluate the surgical outcomes and pulmonary artery (PA) development associated with a new strategy wherein the modified Norwood (N) procedure is performed at 1-2 months after bilateral pulmonary artery banding (PAB). Methods. Between January 2008 and February 2010, 16 patients underwent Norwood-type operation after previous bilateral PAB. For analysis, patients were divided into two groups. Group I (n = 11) underwent modified Norwood procedure with either right modified Blalock Taussig (RMBT) shunt (n = 4) or right ventricle to pulmonary artery (RV-PA) conduit (n = 7). Group II (n = 5) underwent Norwood procedure plus bidirectional Glenn anastomosis. Diagnoses were hypoplastic left heart syndrome in 6 and its variants in 10. Results. There was no surgical death and no late death. Pulmonary artery interventions were performed at the time of the Norwood procedure in 27% in Group I and in 100% in Group II (p < 0.05). Additional PA interventions were performed during the period of follow-up in 4 cases in Group I (36.4%), and in 4 cases in Group II (80.0%). Additional Blalock Taussig shunts were performed in 7 patients, resulting in significant increase in PA index. In all, four patients have reached total cavopulmonary connection, and one has undergone biventricular repair. Eight patients in Group I and one patient in II Group reached bidirectional Glenn anastomosis. In Gp II, two patients showed LPA narrowing or obstruction with PA index of 80 ± 12 mm(2)/m(2). Conclusions. Regarding the second-stage palliation after bilateral PAB, modified Norwood procedure with either RMBT or RV-PA conduit has some advantages compared with Norwood plus BDG with respect to subsequent pulmonary artery development. Additional BT shunt may contribute to PA development, even in the patients with Norwood procedure with RV-PA conduit.
背景。本研究的目的是评估一种新策略相关的手术结果和肺动脉（PA）发育情况，该策略是在双侧肺动脉环扎术（PAB）后1 - 2个月进行改良诺伍德（N）手术。方法。2008年1月至2010年2月期间，16例患者在先前双侧PAB后接受了诺伍德式手术。为进行分析，将患者分为两组。第一组（n = 11）接受改良诺伍德手术，采用右改良布莱洛克 - 陶西格（RMBT）分流术（n = 4）或右心室至肺动脉（RV - PA）导管（n = 7）。第二组（n = 5）接受诺伍德手术加双向格林吻合术。诊断为6例左心发育不全综合征及其变异型10例。结果。无手术死亡和晚期死亡。第一组27%的患者在诺伍德手术时进行了肺动脉干预，第二组为100%（p < 0.05）。在随访期间，第一组4例（36.4%）和第二组4例（80.0%）进行了额外的PA干预。7例患者进行了额外的布莱洛克 - 陶西格分流术，导致PA指数显著增加。总共有4例患者完成了全腔静脉 - 肺动脉连接，1例患者接受了双心室修复。第一组8例患者和第二组1例患者完成了双向格林吻合术。在第二组中，2例患者出现左肺动脉狭窄或阻塞，PA指数为80 ± 12 mm²/m²。结论。关于双侧PAB后的二期姑息治疗，与诺伍德加BDG相比，采用RMBT或RV - PA导管的改良诺伍德手术在后续肺动脉发育方面具有一些优势。即使在接受RV - PA导管诺伍德手术的患者中，额外的BT分流术也可能有助于PA发育。
